Dispensing a Dose of Sensitivity to Ease Pain : UCSD Class on Women’s Health Issues Prescribes Compassion for Patients

Emily Chang had thought postpartum depression was the frivolous fare of daytime television talk shows until she heard a woman describe how the disorder twisted her life.

Cheryl Denenberg found herself in tears as a mother described the death of her child. And as Cheryl Serr listened to a woman describe being raped, Serr remembered trying to comfort her own best friend after a similar assault.

The topics don’t sound like the stuff of medical school classrooms. But they are.

The three UC San Diego medical students attend an elective class focusing on women’s health issues--one of an increasing number of courses geared toward “sensitizing” would-be doctors.

“We are entering a whole new realm of change in medical school education,” said Brownell Anderson, director of educational programs with the Assn. of American Medical Colleges. “First of all, there is a major--not revolution--but evolution under way in medical school curriculum.”

In medical schools here and across the country, changes are rapidly occurring as school officials seek to produce more compassionate doctors. And yet, when it comes to women patients and women doctors, many acknowledge that the field of medicine has a lot of catching up to do.

Hoping to help bridge the gap at the UCSD School of Medicine, Deborah L. Wingard, associate professor of epidemiology, teaches a class on women’s health issues--a course that delves into issues that affect women and examines how doctors treat female patients.

Her goal with the course is “to make sure this next generation of physicians is sensitive and caring--not just technically knowledgeable,” Wingard said. “I targeted women’s health issues because it’s an area that doesn’t get enough attention.”

Each class pounds home a message about pain, suffering and how a doctor either eased or worsened a family member’s or patient’s plight. Rape victims spoke of their ordeals after the assault. Cancer patients described how they felt having a breast removed. Parents talked about the death of a child. And a panel of women and one man discussed the agony caused by their fertility troubles.

“When students come to medical school, their goal is to treat patients and to help people. That goal gets lost in a morass of course work,” Wingard said.

“This course helps to keep perspective. These people have real faces, real tears. When the students are treating patients 10 years from now, will they remember what they heard these patients say? I hope so.”

The problems for women are widespread in the profession, Wingard said. And the examples abound.

At Stanford University, for instance, a group of female medical students met with the Faculty Senate to complain about sexism last year. There, too, Dr. Frances Conley--one of the first fully tenured woman professors of neurosurgery at Stanford--resigned last spring because of what she viewed as sexual harassment.

And the difficulties facing women spill over into the examining rooms and onto operating tables, Wingard said.

In January, Christina Allen, a first-year medical student at UCLA, accompanied a patient to a Los Angeles-area hospital so she could observe the birth of the woman’s baby. Allen, 30, was shocked by the coldness and insensitivity of the doctor and nurses.

“The whole attitude of the staff was, ‘Buck up, this is tough on all of us,’ ” Allen said. “Everyone seemed (irritated) that the patient was in pain.”

After the woman’s baby was born, she required a surgical operation. When the surgeon entered the operating room, she spoke only once to the patient. As she set up a screen so the patient could not see below her waist, the surgeon said one word: Bye.

“I couldn’t believe it,” Allen said. “There was no ‘I’m Dr. so-and-so.’ Nothing.”

This scenario is exactly what Wingard hopes to prevent among the crops of young doctors who attend her class.

When Wingard first began designing a course on women’s health issues six years ago, she intended it to be a technical research course, reviewing epidemiological studies and women’s risk factors for contracting certain diseases.

But as she taught the class, she gradually realized that her original idea of the course was very much like most classes that the students already had. As she thought about the course, it seemed like the most interesting classes were the ones in which the students strayed from the curriculum, discussing the social aspects of diseases.

The more Wingard taught, the more she realized that, in fact, her students didn’t seem to know much about areas that she believed they had already studied.

“I assumed all medical students were taught how to deal with a rape victim, but that was not a routine part of the curriculum,” Wingard said. “The human side, the social side was out of balance with the technical side of medicine.”

Today, Wingard’s class scarcely resembles the one she set out to teach. Week after week, 25 students now sit in a circle, and tears are not uncommon as they listen to the mostly female speakers.

With each class, Wingard and her students try to determine: What questions did a doctor ask that made the patient feel even worse in an already difficult situation? Were there other ways to obtain the same information? How would the patient have wanted the doctor to act?

Many times, the doctors come under heavy fire from patients--a perspective that some students take into account.

“I felt there were some (patients) I take with a grain of salt. The patient is always looking at it from the patient’s point of view. But a doctor is always busy. They are limited in their time,” said Chang, 22, a first-year medical student.

To Wingard’s chagrin, all but two of the 25 students in her class are women. It’s a ratio that she hopes may one day even out. Mario Ruiz, a second-year medical student, said it took a while getting used to being among so many women in a class.

But because he believes he needs to be able to understand female patients in his family care practice, Ruiz signed up for the course.

“I needed to be more attuned to how females speak. They tend to think differently and approach life differently than we (males) do,” said Ruiz, 26. “Hopefully, this will make me a better rounded, more sensitive physician.”

For Chang and others, the class opens up areas of medicine they thought they already understood. In the class on breast cancer, patients described how they felt having a breast surgically removed, how long it took for the emotional scars to heal.

“You hear so much about breast cancer, you think you are not going to learn anything new,” Chang said. “But I learned a lot about losing a breast--the emotional side.”

In taking the course, Serr suddenly realized how much was missing from her other classes.

“We had psychology class lectures on depression but postpartum depression was never mentioned,” said Serr, 24, a second-year medical student. “Courses like this address questions and issues that are lacking in medical education.”

The problems facing women patients and women doctors, many critics say, are a reflection of the profession, which has slowly evolved to include increasing numbers of women.

In recent years, a growing chorus has protested government funding of research studies that fail to include women. One federally funded study, for instance, looked at 22,000 men to analyze the effects of aspirin in preventing heart attacks.

In response, the National Institutes of Health launched the Office for Research on Women’s Health in September, 1990--a gesture that officials hope will send a strong signal to the medical community. The office touts a $500-million budget, which will be used for studies of health issues that affect women, such as osteoporosis, heart disease, and cancer.

“It is our hope that medical schools and the practicing community will take an even greater interest in the health concerns of American women,” said NIH spokesman Mark Stern. “We hope this has a positive impact in medical schools.”

Doctors and medical school officials say they are getting the message.

“There are more women in medicine, more women in health care and these women are making us more aware of things we had not been doing,” said Dr. William Jacott, a trustee of the American Medical Assn. and a family physician at the University of Minnesota. “It’s become pretty clear that many of our studies, initiatives, and directions have not been in the direction of women’s health care. Part of that has been historical--not deliberate.”

Today, the quickly changing landscape of medical practice has pushed most schools to evaluate their curriculum as well as the doctors they produce.

Among many schools, the curriculum itself has undergone a face-lift. Today, schools routinely offer classes in medical ethics. In 1979, 10 medical schools offered an elective course on death and dying. This year, 115 schools offer it as a required course.

At UCSD, the curriculum includes what might have once been condemned as “touchy-feely” classes such as “Achieving Well-Being: Stress Management for Health Professionals and Their Patients.”

“Overall, probably every medical school in the country has been looking at its curriculum for ways it can teach better,” said Dr. Gerard N. Burrow, dean of UCSD’s School of Medicine.

But the changes reach further, affecting the very admissions process.

Medical school entrance exams, the Medical College Admissions Tests, or MCATS, were revamped last year. The new tests--administered to almost 40,000 prospective medical students a year--include essays meant to gauge students’ ability to think and write. The changes, officials say, came in response to criticism that the test required rote memorization of facts.

“There’s a lot of concern among patients that medical schools are turning out callous, insensitive, greedy physicians. I don’t think it’s an unrealistic assessment,” said Dr. Michael Wilkes, professor of medicine at UCLA’s medical school and chairman of a new segment of the curriculum called the doctoring program, which is designed to bring the student into realistic situations and help them understand the patient’s perspective.

“I haven’t talked with a patient in years who hasn’t complained about the way doctors treated them, kept them waiting, and treated them with no respect,” Wilkes said. “Have you ever had an encounter with a doctor that you enjoyed? “